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Application <br />-for- <br />Certificate of Appropriateness <br />Historic Preservation Commission of South Bend & St. Joseph County <br />125 South Lafayette Boulevard <br />Mailing address: 227 West Jefferson Blvd - South Bend IN 46601-1830 <br />Phone: 219-235-9798 Fax: 219-235-9578 e-mail: historic@nuchiana.org <br />A Certified Local Government <br />OFFICE USE ONLY>>»»DO NOT COMPLETE ANY ENTRIES CONTAINED IN THIS BOX«««OFFICE USE ONLY <br />Date -Received G 7 2002 Application Number: 2002- 06,0 7 <br />Past Reviews: ❑ YES (DArzoFlAsrPjV16N9 NO <br />StatTApproval authorized by: /��Title: <br />Historic Commission Review Date: <br />❑ Local Landmark <br />❑ National Register District pre".): <br />XIAcal Historic District p+). <br />Certificate of Appropriateness: <br />❑ Denied <br />❑ Approved and Issued <br />❑ National Landmark <br />ker yi <br />U <br />❑ Tabled ❑ Sent To Committee <br />2002 <br />Address of Property for proposed work: /moi , Ivoy. {vo4 4 -, Y, Eorr, Se Rt -O, i•, <br />�+ Strwf7""SaodSreNNam) � <br />City : - ovrif Owner's Phone No: Sly —,Z 8'� V.t &J <br />— <br />Name of Property Owner(s):(FR1Nn 1--'-rr a rF air 1,4 1.4.8,7, <br />Address of Property Owner: 111,o)- <br />Contractor(s) <br />'joZContractor(s) Name: O'o � E <br />Contract Company Name: .von. <br />Contractor Address: ^'/A City: <br />Contractor's Phone No: W /4 <br />Current Use of Building: /Vt, c. fi <br />(Sim& Family • MuW-Family. CommmW- Corernment - Indwoial- Vacant - eta <br />Type of Building Construction: Gve ev <br />(Wood F}amt-Mck •Stone-Steil-C—ete-Otho) <br />Proposed Work: ❑ Inkind ❑ Landscape ❑ New ® Replacement(nw;n-hind) <br />(mon than one boa may be checked) <br />F Demolition <br />Description of Proposed Work: / ,, .v--.., wi-.00wrJ S, e1,.4 , <br />Asp,—? <br />o d' <br />Owner/CosttrattCr:'-•Fax: e-mail: <br />(T)ds officel-H mrrupold rith only one dealynee) <br />�iZ���D�� Psi�re..s� �R•���s�r�r -- <br />Signatureof Owner Signature of Contractor _ <br />APPLICATION REQUIREMENTS ARE LISTED ON REVERSE SIDE. <br />